US20070249990A1 - Automatic smoke evacuator and insufflation system for surgical procedures - Google Patents

Abstract

An automatic smoke evacuation and insufflation system for surgical procedures having a vacuum for removing gas, smoke, and debris from a surgical site and an insufflator for supplying gas to the body cavity of a patient.

Description

FIELD OF INVENTION
• The present invention generally relates to an automatic smoke evacuator system for surgical procedures having a means for the insufflation of the abdominal cavity; and replacement of gas which is removed from the abdominal cavity as a result of the smoke evacuation which is performed during the surgical procedures. More specifically, the present invention relates to an automatic smoke evacuator having insufflator means wherein the insufflator means initially fills the intra-abdominal cavity with a desired pressure and then replaces the gas removed by the smoke evacuator at the same flow rate and at the same time at which the smoke evacuator is activated.
BACKGROUND OF THE INVENTION
• The apparatus described in the U.S. Pat. No. 5,199,944 can remove a precise volume of gas, along with the smoke, from the abdominal cavity during surgical procedures. The flow of the gas removed can be adjusted precisely and is determined by the potential of the insufflator which is used. The insufflator can quickly and efficiently replace the same volume of gas that is removed with the smoke evacuator.
• While this design works very well in normal conditions, the efficiency in many instances where the insufflator has a low flow rate is diminished since the smoke evacuator flow has to be very low in order to maintain the intra-abdominal pressure. Another inconvenience results from the fact that the insufflators available on the market react to the drop in pressure associated with the gas that is removed by the smoke evacuator; and to the leads which activate and insufflate the gas at a lower rate when the difference between the adjusted pressure and the peritoneum pressure is small. Accordingly, the insufflator in the prior art needed a larger drop in pressure in order for the flow to increase and be useful. However; a large drop in pressure would result in the collapse of the peritoneum which would be very dangerous when performing the surgery.
• The insufflators currently available on the market deliver an intermittent flow of gas because the pressure in the peritoneum can not be measured while the gas is flowing through the tubing. Further, this intermittent flow is inconvenient because the suction from the smoke evacuator is continuous.
• Even with all the previously described inconveniences, the smoke evacuation performed by the automatic smoke evacuator described in U.S. Pat. No. 5,199,944 was very helpful, relatively efficient, and more superior to all the laparoscopic smoke evacuators existing on the market at the time. Nevertheless, improvements to the design are necessary to overcome some of the inconveniences described and these improvements are the subject of this invention.
• In this invention a new and improved smoke evacuator is described having an increased efficiency and many patient safety features. The smoke evacuator presented in this invention can safely and efficiently remove the insufflation gas from the peritoneum. This will reduce or eliminate the pain and discomfort associated with laparoscopic procedures since this pain and discomfort are due to the slow absorption of the CO₂gas left in the peritoneum by the patient tissue.
• The smoke evacuator also has a vacuum sensor which will shut off the smoke evacuator if patient tissue is trapped in the instrument; and which will turn on the smoke evacuator when the tissue is released. It will also illuminate a “change filter” caution indicator when the filter is dirty and its efficiency is reduced.
• The smoke evacuator also has a pressure sensor which will automatically turn on the smoke evacuator if the intra-abdominal pressure reaches unsafe limits. This is a very important feature because excessive pressure within the patient can cause an embolism which can be deadly. The new pressure sensor is used for the insufflation part of the apparatus to determine the intra-abdominal pressure when the smoke evacuator includes the insufflation means.
• As described above; one of the deficiencies of the laparoscopic smoke evacuator described in U.S. Pat. No. 5,199,944 was that the insufflators could not always keep up with the smoke evacuation. In the design of the present invention, that problem is completely solved by having an insufflator added to the smoke evacuator which, besides initially insufflating the peritoneum with the desired pressure, will automatically replace the volume of gas eliminated by the smoke evacuator at exactly the same time with exactly the same flow so that the peritoneum will remain with the same pressure that has been chosen by the surgeon. In order for the combination smoke evacuator/insufflator to work correctly the smoke evacuator has to be completely automatic. In other words, the smoke evacuator has to start only when the surgical device laser or ESU is activated, and at the same time deactivate shortly after the surgical device is deactivated. Otherwise, if the smoke evacuator functions continuously, the insufflator must continuously replace the gas which will result in excessive gas waste and an operating room that will become filled with that gas, which is typically CO₂.
• Also, in the past, recirculators were used and attached to the insufflator in order to eliminate the smoke. Recirculators suction gas from the abdomen, filter the smoke, and return it to the abdomen. However, recirculators present many deficiencies and are prone to creating excessive pressure conditions within the patient's body. None of the safety features described above with respect to the present invention are found in recirculators.
SUMMARY OF THE INVENTION
• A principle object of the present invention is to provide a much improved smoke evacuator for laparoscopic procedures with an adjustable and precise flow and with a solenoid valve that will open only when the smoke evacuator is activated. The solenoid valve is normally closed so that no gas will escape. This is necessary so the intra-abdominal pressure can be easily maintained.
• Another object of the present invention is to provide a smoke evacuator with a pressure sensor for monitoring the intra-abdominal pressure. If the intra-abdominal pressure exceeds a certain preselected level, the smoke evacuator automatically turns on thereby reducing the pressure to a safe level. The same pressure sensor is used to caution the staff if the patient is not attached to the smoke evacuator. The sensor also can be used for monitoring the intra-abdominal pressure for the insufflator if a separate insufflator is attached to the smoke evacuator.
• It is still another object of the present invention to provide a smoke evacuator with a vacuum sensor which will turn the smoke evacuator off if the instrument becomes obstructed or occluded with tissue or other elements.
• It is yet another object of the present invention to provide a smoke evacuator with an insufflation potential which will initially safely insufflate the abdominal cavity, and then monitor the pressure so it is maintained at a desired level by simultaneously using an insufflator to replace the volume of gas removed by the smoke evacuator at the same rate that the gas is being removed by the smoke evacuator.
• Another object of the present invention is to provide a gas warmer for high flow rate. The warming temperature will depend on the gas flow rate and will be directly proportional with the flow rate. The higher the flow rate, the higher the temperature.
• It is important to mention that while the smoke evacuator described in this invention can be, and is, used as a separate unit, the insufflator described in this invention cannot be used without being included in the smoke evacuator described in this invention since the pressure described in the smoke evacuator portion of the invention is also used as the main pressure sensor for the insufflator. Without this pressure sensor, the insufflator will not function.
• It is still another object of the present invention to provide a high flow insufflator with improved patient safety features.
• In accordance with one embodiment of this invention, an automatic smoke evacuator unit system and apparatus for open and endoscopic/laparoscopic procedures is disclosed comprising, in combination, a vacuum pump means for providing the necessary vacuum for removing the smoke and debris from the surgical site in open and/or laparoscopic procedures, and a pump control means for controlling the activation and deactivation of the pump when the surgical device is activated.
• The pump control is connected with an off time delay mechanism which will keep the pump running several seconds after the surgical device has been deactivated. The time delay period for shut off can be adjusted by the adjusting pot. The OFF time delay is connected with a laser sensor which will activate the off time delay when the laser is activated. An ESU sensor will activate the off time delay when an ESU is activated. A manual switch bypasses the sensors and activates the smoke evacuator when the switch is on.
• The automatic smoke evacuator system and apparatus also comprises a solenoid valve which will open the flow pass when the smoke evacuator is activated for open procedures that are conducted with a high flow rate. A second solenoid valve will open when the smoke evacuator is activated for laparoscopic procedures.
• A flow sensor for laparoscopic flow will show the precise flow rate when the smoke evacuator is activated and will exhibit more functions when the smoke evacuator is used with the insufflator function. This will be explained in detail with reference to the second embodiment.
• The automatic smoke evacuator system and apparatus of the present invention also comprises a pressure sensor connected to a first comparator that will activate a relay where the contact for the relay will close, sending a signal to activate the vacuum pump. This will only happen when the pressure measured by the pressure sensor exceeds the maximum limits that are set in association with the other side of the first comparator (this is the reference voltage).
• A second comparator will identify when no pressure is present. The pressure sensor will have more functions when used with the insufflator presented in the second embodiment. A vacuum sensor is connected to one side of the second comparator and the output of this comparator is connected with an adjustable off time delay and the output of the off time delay is connected with a relay. The contacts of the relay will turn off the vacuum pump and close the solenoid valve if the vacuum level is too high and an occlusion is present. The other side of the second comparator is connected to the flow and vacuum level adjustor. This too will have more functions in the second embodiment.
• A first filter means is also included for filtering the smoke and debris which is evacuated using the smoke evacuator, and a fluid trap is present for preventing the fluids from reaching the vacuum pump. The first filter is connected through tubes and through solenoids to one side of the vacuum pump. A second filter for filtering gases and odor is located on the output side of the vacuum pump.
• In accordance with yet another embodiment of this invention an automatic smoke evacuator system and apparatus having an automatic insufflation means is presented which includes, in combination, an automatic smoke evacuator means identical with the smoke evacuator described in the first embodiment and an insufflator means which initially fills the intra-abdominal cavity with a desired pressure and then automatically replaces the gas removed by the smoke evacuator at the same flow rate and at the same time that the smoke evacuator is activated.
• The insufflation means comprises a gas source under pressure, a high pressure filter means for stopping particles and bacteria present in the gas tank, a high pressure sensor which will measure the volume of gas existing in the gas tank, and a pressure regulator for dropping the pressure to a working pressure. Further, the gas will pass through a safety solenoid. The safety solenoid will shut off the gas flow if the patient's intra-abdominal pressure exceeds the adjusted maximum pressure.
• The automatic smoke evacuator system and apparatus having an automatic insufflation means of the present invention further comprises a mechanical release valve which will let the gas escape if the gas pressure exceeds the pressure adjusted at the pressure regulator. This safety measure is for protecting the patient against an increase in the working pressure in the event of a failure with the pressure regulator or a failure with the adjustor for the pressure regulator. From the mechanical release valve, the gas will pass through a proportioned solenoid valve. The proportioned solenoid valve will adjust the precise flow rate delivered to the patient when adjusted by the flow adjust or by the flow rate of the smoke evacuator flow meter. Accordingly, when the smoke evacuator is activated, the insufflator will simultaneously deliver gas at the exact flow rate at which the smoke evacuator is removing gas, smoke, and debris in order to efficiently replace the gas removed by the smoke evacuator.
• The proportioned solenoid valve will also have a role in safety by shutting completely off when the pressure exceeds the desired adjusted pressure or if the insufflator flow is higher than the smoke evacuator flow. Further, an exhaust solenoid valve will let the gas escape if the pressure rises over the desired predetermined pressure, or if the flow of the insufflator is higher than the flow of smoke evacuator. The solenoid therefore has the role of balancing the pressure. This exhaust solenoid valve will be the first to be activated and, only if the pressure is still rising, will the proportioned solenoid valve completely shut off. If the pressure is still rising, then the smoke evacuator is automatically activated so that gas is actively and rapidly removed in order to reduce the danger of embolism. This is a safety feature that is unique to this apparatus.
• Further in line is a flow meter which will display the real flow rate of the insufflator. Also, the flow rate measured by this flow meter is continuously compared with the flow meter readings from the smoke evacuator so that if the flow rate of the insufflator is higher than the flow rate of the smoke evacuator, the safety feature described above will immediately activate. The flow meter for the insufflator will also control the gas temperature by sending a signal proportional with the flow level to the gas warmer.
• A patient pressure sensor will measure the patient's abdominal pressure only when a needle is used. It will also help to locate the position of the needle in the peritoneum. The pressure sensor on the insufflation line will have an active role in normal use only when there is no insufflation flow. This is due to the fact that while the gas is flowing through the insufflation tubing, the resistance in the line will create higher pressure giving a distorted reading of the real intra-abdominal pressure thereby turning the insufflation off because of excessive pressure even if there is no intra-abdominal pressure. In this situation, the active role of the pressure readings during the insufflation will be taken by the pressure sensor for the smoke evacuator. Therefore, the insufflation apparatus described in this application cannot be used as a stand alone unit; it can only be used in combination with the automatic smoke evacuator system and apparatus described as the first embodiment.
• The second embodiment of the present invention directed to the automatic smoke evacuator system and apparatus having an automatic insufflation means further comprises a gas warmer which is different than any previous gas warmer design because the temperature of the gas warmer is automatically adjusted by the gas flow rate and not by the exact temperature. The gas warmer turns ON and OFF to maintain that temperature. In existing gas warmer designs, the gas is warmed to a certain temperature regardless of the gas flow rate. However, that system is not adequate because the higher the flow rate of the gas, the cooler the gas will become when expended in the abdominal cavity. Therefore, if the temperature is adjusted too low in existing gas warmers, the drop in gas temperature will increase and the resulting low temperature could freeze the tissue. On the other hand, if the temperature is high enough for a high flow rate, then in a low flow area where the expansion of the gas is much lower, the gas will be too hot and will burn the patient because the drop in temperature will not be great enough.
• In the gas warmer design of the present invention, the flow rate itself will adjust the gas temperature. The higher the flow rate, the higher the temperature of the gas warmer and the lower the flow rate, the lower the temperature of the gas warmer.
BRIEF DESCRIPTION OF THE DRAWINGS
• FIG. 1 represents a base schematic of a first embodiment of the automatic smoke evacuator and insufflation system and apparatus of the present invention. This embodiment is presented as a stand alone apparatus with special safety features.
• FIG. 2 represents a base schematic of a second embodiment of the automatic smoke evacuator and insufflation system and apparatus of the present invention shown inFIG. 1 having an automatic insufflator means for maintaining the appropriate gas pressure within a patient's abdominal cavity.
DETAILED DESCRIPTION
• FIG. 1 depicts an automatic smoke evacuator and insufflation system andapparatus10. The exact sequence of the system and apparatus set up and operation will be followed in the detailed description of this first preferred embodiment of the invention.
• Starting with the set up of the system and apparatus, the unit is turned on at theON switch12 which can be set on high or low depending on whether the surgical procedure is open or laparoscopic. The ON switch12 is set in the low position for laparoscopic procedures and thelow light14 will be illuminated. Afirst relay16 is not activated so the contacts remain in the normal non-energized position and a ground signal is present at the first contact16a. The ground signal is sent to the ground side of afirst solenoid valve18. A three waysecond solenoid valve20 is normally closed to afirst tubing22 and normally open at asecond tubing24. The three waysecond solenoid valve20 will stay this way and in this mode since the ground side of thesecond solenoid valve20 is open as a result of the open second contact16bof thefirst relay16.
• The third contact16cof thefirst relay16 is closed which results in a signal being sent to thebar graph26 on the low flow rate side so that when the second part of theflow adjusting pot28 is set to a certain flow rate, thebar graph26 will reflect the flow rate at which the smoke evacuator will function. The first part of the double adjustingpot28 will send the adjusted flow signal to the second contact30bof thesecond relay30.
• The LASER and ESU sensors (not shown) will be connected to first and second contacts32a,32b, respectively, which are parallel to one another. Themanual switch34 can bypass the sensors thereby enabling the automatic smoke evacuator system andapparatus10 to be activated manually. When a laser or an ESU unit is activated, its respective sensor will send an ON signal to theoff time delay36. The adjustingdouble pot38 will adjust theoff time delay36 which is the time that the smoke evacuator will continue to work after the LASER or ESU unit is deactivated and the ON signal is removed. This is necessary to ensure that all of the smoke will reach the filter and that none of the smoke is trapped in the tubing. The second part of the adjustingdouble pot38 will control afirst display40 which will display the adjusted delay time.
• A signal is sent from theoff time delay36 tosecond relay30 which is then activated. Thesecond relay30 has first and second contacts30a,30bwhich are normally open. When thesecond relay30 is activated, the first and second contacts30a,30bwill close and send a signal through first and second contacts42a,42binthird relay42 which are normally closed. The signal will continue to both thefirst solenoid valve18 and thesecond solenoid valve20, but only thefirst solenoid valve18 is activated because the ground is received from the first contact16aof thefirst relay16 and thesecond solenoid valve20 has an open ground at the second contact16bof thefirst relay16.
• By opening thefirst solenoid valve18, the flow is opened throughthird tubing44 andflow rate meter46. At the same time, the second contact30bof thesecond relay30 will close sending the adjusted flow signal from theflow adjusting pot28 through the normally closed first and second contacts42a,42bof thethird relay42, to thepump control48 thereby turning on thepump50 with the exact flow rate that has been adjusted byflow adjusting pot28.
• Afourth relay52 has the contact (L) closed in the normal position so that theflow rate meter46 will send the flow rate reading to asecond display54.
• The flow line is now open through the low side for laparoscopic procedure. The direction of the flow is as follows:
• When the pump is activated and the first andsecond solenoid valves18,20 are open, a suction is applied at thefilter56 by thevacuum pump50. Gas, which includes smoke, debris and sometimes accidentally fluids, is sucked from the patient through the tubing, and will reach theULPA filter56 which has a fluid trap for the fluids. The smoke is filtered by thefilter56 and the clean gases will pass through thefirst tubing22, up to theY connector58, and then through theflow rate meter46. The clean gases will continue to pass through thefirst solenoid valve18, through the normally open side of the three waysecond solenoid valve20 to pump50, and then through thegas filter60 which will filter the gasses and odor. This is how the first embodiment of the present invention functions during normal conditions in the laparoscopic mode.
• If tissue is trapped, or any kind of occlusion condition appears, then thevacuum sensor62 will detect it and send a signal to thefirst comparator64 if the occlusion or obstruction condition level is higher than the limit adjusted by adjusting pot64a(the reference value). Thefirst comparator64 will send an ON signal to the second offtime delay66, and from theoff time delay66 the signal is then sent to an audio andvisual alarm68 and to thethird relay42 which will open the normally closed contacts42a,42bthereby stopping thepump50 and closing thesecond solenoid valve20.
• Thesame vacuum sensor62 will send a signal to asecond comparator70 which has the adjusting pot70breference adjusted for a lower vacuum level. This will turn on a “change filter” light72 when the resistance in thefilter56 increases as a result of filling up with smoke particles. This ensures that thefilter56 will not continue to be used if the efficiency is dropping. If thefilter56 is not changed after becoming full, the system andapparatus10 will shut off shortly afterwards because the resistance in thefilter56 will reach a higher level which will be read as an occlusion.
• If the intra-abdominal pressure is too high, then thepressure sensor74 will send a signal to thethird comparator76. If the pressure is above the safe pressure limit adjusted by the adjusting pot76a(the reference value), then an excessive pressure signal is sent to the second audio andvisual alarm78 and to afifth relay80 so that the normally open contact80awill close and send an ON signal tooff time delay36. Thepump50 will turn ON and thesecond solenoid valve20 will open so the gas from the intra-abdominal cavity will be allowed to be suctioned until the pressure is brought to safe levels.
• Thesame pressure sensor74 is used to sense whether the tubing is attached to the patient since the pressure will be zero if the patient tubing is not attached. When the tubing is attached to the patient, pressure is present which will be read by thepressure sensor74 which will send a signal to afourth comparator82. The minimum pressure is adjusted by the adjusting pot82a. When the pressure is zero, the nopressure light84 is on. When pressure sensed by thepressure sensor74 is higher than the level set by the adjusting pot82a, the no pressure light84 will go OFF.
• In a high flow rate mode, theON switch12 will be in thehigh light86 position. Thefirst relay16 is energized and the contacts will switch to the second and fourth contacts16b,16d, respectively. The second contact16bwill put a ground to thesecond solenoid valve20, and remove the ground fromfirst solenoid valve18 so that when the smoke evacuator is activated, thesecond solenoid valve20 will open the flow on thefirst tubing22 and will close the flow on thethird tubing44. Thefirst solenoid valve18 will also stay closed because the ground is removed. The adjusted flow rate will be much higher and this will be reflected on thebar graph26 which is now energized from fourth contact16doffirst relay16.
• Thefourth relay52 will change contacts to (H) so it will read the flow rate through the F/V converter88. This invention presents two ways to read the flow rate. One way is to read the flow rate through theflow meter46 and the other way is to read the flow rate by reading the frequency delivered by rotation of the pump. Both methods can be used either simultaneously or separately. This will not depart from the purpose of the present invention.
• The differences described above with respect to the high flow rate mode are the only differences between the high flow rate mode of the present invention for open surgical procedures and the low flow rate mode of the present invention for laparoscopic surgical procedures. Everything else is identical in both modes and therefore will not be repeated. The one exception is that thepressure sensor74 will not be used in open surgical procedures since there is no abdominal pressure which must be maintained for open surgical procedures.
• FIG. 2 depicts an automatic smoke evacuator system and insufflation and apparatus having an insufflation means in accordance with the present invention which enables a patient's intra-abdominal pressure to be maintained throughout laparascopic surgical procedures.
• The smoke evacuator and insufflation system and apparatus portion of the second embodiment is identical with the one described inFIG. 1 in relation to the first embodiment. Therefore, the detailed description of the second embodiment which related to the smoke evacuator and insufflation system and apparatus will not be repeated; instead, only the system and apparatus relating to the insufflation means will be described. The set-up and function of the entire apparatus when used with a patient for laparoscopic surgical procedures will be described.
• The patient is connected for the smoke evacuation through the tubing at thefilter56 as mentioned above. The smoke evacuator side set-up and function of the second embodiment shown inFIG. 2 is identical with the one described inFIG. 1. Turning now to the insufflation side, the patient is attached through the tubing at thesecond filter100 for insufflation. Thegas tank102 is installed and the valve is open so the high pressure side is activated. Thethird filter104 will filter the gas on the high side so that no debris will enter the apparatus and be transferred into the patient. Theinsufflation pressure sensor106 will read the gas tank pressure and will show the volume of gas in thetank102 onvolume display108.
• At first, the insufflation is performed through a needle in order to safely prepare the patient for introducing a working CANULA. At this time, the smoke evacuator side will not be attached because there is no place to attach it to. Therefore, thevacuum pressure sensor74 cannot read any pressure and cannot be used for the initial insufflation.
• If the operator attempts to use the insufflator in the normal mode for the needle, the zero pressure at thevacuum pressure sensor74 will activate the no pressure light84 through thefourth comparator82. At the same time, a signal is sent through the normally closed contact110bof asixth relay110 to aseventh relay112 which will activate the normally closed contact112a. Theproportional solenoid114 will not open because the signal sent by the pressure adjust116 through thefifth comparator118 will he interrupted. The normally open contact112bwill close and a signal will be sent to avisual warning120 and anaudible alarm122, which can be a voice message warning the personnel to switch to a needle position. This safety factor is necessary to ensure that no excessive pressure conditions result since theactive pressure sensor74 is not connected to the patient.
• During correct use, theinsufflation switch124 will be switched to the needle position. This will activate aneighth relay126 and thesixth relay110 and at the same time thesixth relay110 will open contact110b,which is normally closed, and the nopressure signal84 from thepressure sensor74 can not reach theseventh relay112, so no alarm condition will be read. At the same time, a power-up once shot128 is activated and a simple pulse signal is sent to a latchingrelay130 which will close contact130a, which is normally open, and will switch from contact130bto130con the other contacts. The OP AMP132 will send a signal through contact130cof latchingrelay130 to theproportional solenoid valve114 so that a very small flow of gas is released. This low flow rate will read a minimal resistance in line but as long as the needle is not in the intra-abdominal cavity, it will show an occlusion and apressure sensor134 will read it. The signal will reach asixth comparator136 through contacts in the latchingrelay130 which are now closed. Thesixth comparator136 will send a signal through atransistor138 to aspecial timer140 which will energize but not activate. At the same time, a visual sign will indicate that the needle has penetrated the abdominal wall but has not reached the intra-abdominal cavity for a safe insufflation. As the needle is pushed forward, the needle will reach the intra-abdominal cavity. The occlusion condition is eliminated and the signal of the input from thetimer140 will stop. The warning light will go off and thetimer140 will activate with a pulse delivered at the other side of the latchingrelay130, switching the contact130ato open and contact130cto contact130b. This will establish the connection between adifferential amplifier142 and theproportional solenoid114 for needle insufflation. This flow rate will be much higher than the previous flow rate but smaller than the maximum flow rate in normally functioning conditions.
• As mentioned previously, wheninsufflator switch124 is in the needle position, theeighth relay126 is activated. Therefore, contact126bwill be switched to126aand the connection between flow adjust144 and theproportional solenoid114 is made through thedifferential amplifier142 so the maximum flow rate will be much lower than normal conditions. Also, contact126c, which is normally open, will close sending a signal topulse timer146 which in turn will send an alternative ON and OFF signal to aninth relay148 which will alternate open and closed between normally closed contact148aand normally open contact148b.
• When contact148ais closed, the signal from the fifth comparator118 (which will send a signal as long as the pressure is below the pressure adjusted by pressure adjust116) will send a signal through the normally closed contacts112a,42band a tenth relay150, to the ON/OFF of theproportional solenoid114 turning it ON. When contact148ais open, theproportional solenoid114 will shut OFF allowing thepressure sensor134 to measure the intra-abdominal pressure. When contact148ais open, contact148bis closed which will send the pressure reading to thefifth comparator118 for controlling the pressure and the seventh andeighth comparators152 and154, respectively, for safety, and also to apressure display156. When the contact148bis open, the threshold158 will maintain the last reading before the contact148bwas opened.
• When the peritoneum pressure reaches the desired pressure, the canulas are installed and the smoke evacuator tubing is also attached. Thepressure sensor74 is activated and the “no patient” light84 will turn OFF.
• Theinsufflator switch124 will be switched to “normal” and thesixth relay110 and theeighth relay126 will deactivate and the position of the contacts is as shown inFIG. 2.
• The desired pressure is adjusted by pressure adjust116. The signal will go to the reference on thefifth comparator118. The signal will also go to the reference on the seventh andeighth safety comparators152 and154. Under normal conditions, the active side of the comparator is coming from thepressure sensor74 through the contacts of theeleventh relay160 which are normally closed and the contacts of thesixth relay110 which are normally closed. When the pressure atpressure sensor74 is lower than the pressure set by pressure adjust116, thefifth comparator118 will send a signal to the base oftransistor162 which will put a ground on the collector. The ground signal will pass through contacts112aof theseventh relay112, which are normally closed, then through the normally closed contacts42bof thethird relay42, then through the contacts148aof theninth relay148, which are normally closed, and finally through the contacts of the tenth relay150, which are normally closed, which will open theproportional solenoid valve114. The flow which is going to be delivered is determined by the sameproportional solenoid valve114 by receiving a proportional signal from flow adjust144 through the normally closed contact164aof thetwelfth relay164, through the contact126bof theeighth relay126, and then through the contact130bof the latchingrelay130. At the same time, since no fault condition is existing, thesolenoid166 is also energized open by the ground from relay contact168awhich is normally closed. This normally open state of thesolenoid166 is also for safety reasons, so that if energy is inadvertently lost, the normal position of thesolenoid166 is closed. This safety feature is called “fail safely.” The foregoing describes how the insufflation means of the present invention works to provide gas flow to the patient.
• Once the gas flow to the patient has started, it will pass through aprecise pressure regulator170 which will drop the pressure to the desired working pressure. As previously indicated, thesolenoid166 is normally closed, but when the insufflator is ON and the conditions are normal, thesolenoid166 is energized. Thesolenoid166 will be turned OFF if the pressure exceeds the adjusted pressure and theeighth comparator154 will activate the transistor172, which will in turn open the contact168aof thethirteenth relay168 when the ground is removed and thesolenoid166 is closed. Thesolenoid166 will also close if thepressure sensor74 registers high pressure and theeighth comparator154 fails to activate. Then, thethird comparator76 will energize the contact80bof thefifth relay80 which in turn will energize thethirteenth relay168. Contact168ais open thereby removing the ground from thesolenoid166 which will close.
• The flow will pass from thesolenoid166 through a mechanical pressure release valve which will release the flow outside if the pressure exceeds the pressure adjusted at thepressure regulator170. Fromsolenoid174, the flow will enter theproportional valve114, whose function has been previously described above.
• Next, anexhaust valve176 will open if the pressure exceeds the adjusted pressure at thepressure sensor74 and theseventh comparator152. This first safety feature is designed to balance the pressure by releasing some of the gas when the pressure slightly exceeds the adjusted pressure.
• If the intra-abdominal pressure is substantially higher than the adjusted pressure/then theeighth comparator154 will activate thethirteenth relay168 and thesolenoid166 will close. Theexhaust valve176 will then open releasing the gas and theproportional solenoid114 will be closed.
• If the intra-abdominal pressure reaches unsafe limits, thethird comparator176 will activate the contacts80a,80bof thefifth relay80. Further, the smoke evacuator will be activated by closing contact80aand activating theoff time delay36 so the gas will be forcibly removed from the abdominal cavity.
• When the latchingrelay130 is activated, latchingrelay178 is also activated. Both relays need only a pulse signal for activation and will maintain the contact in position until another signal is delivered that will deactivate the relay. In this case/bothrelays130 and178 are activated at the same time and the contact178bof the latchingrelay178 will turn ON a visual and audio signal for excessive pressure, and contact178awill introduce thepressure sensor134 into the circuit. Because there is no gas flow on the insufflator side at this time, thepressure sensor74 cannot be used while the smoke evacuator is being used to remove excess pressure.
• Thepressure sensor134 will monitor the excessive pressure condition by sending a signal through the latching relay contact178a, which is activated so that the contacts178a,178bare closed, and to theninth comparator180 as the active signal. The reference signal comes from the pressure adjust116. So, as the pressure drops and reaches the adjusted level, theninth comparator180 will activate thetransistor182 and a time offdelay184 for maintaining the signal flow for a predetermined number of seconds after the latchingrelay178 is deactivated and contact178aopens so that no signal from thepressure sensor134 will be available.
• At the same time,thirteenth relay168 is deactivated and everything approaches normal. The gas flow passes through theflow meter186, through thepressure sensor134 and into the gas warmer188. The temperature of the gas is determined by the signal received from theflow meter186. The higher the flow rate, the higher the temperature, so it will maintain the same temperature as the patient. From the gas warmer188, the gas travels through thefilter100 and to the patient.
• The functioning of the insufflator described above relates to both normal and excessive pressure conditions where the smoke evacuator side is only used for pressure readings and for the safety of actively turning on the smoke evacuator when the pressure is too high.
• Assume that a patient's intra-abdominal cavity is at normal pressure and that a laparoscopic surgical procedure is about to begin. When a laser or ESU is activated for laparoscopic surgery, the sensor plugged in at theconnector32 will turn on the smoke evacuator via theoff time delay36. The flow is adjusted by theflow adjusting pot28. When the smoke evacuator is activated, the eleventh andtwelfth relays160 and164 are also activated.
• Contact164aof thetwelfth relay164 that comes from INSUFFLATOR FLOW adjust144 will switch to contact164band the signal coming from the smokeevacuator flow meter46 will adjust theproportional solenoid114 to exactly the same flow rate as the smoke evacuator. At the same time, a signal fromflow meter46 andflow meter186 are compared by atenth comparator190 which will turn theexhaust valve176 ON if the insufflator flow is slightly higher than the smoke evacuator flow. If the flow of the insufflator is substantially higher than the smoke evacuator flow, aneleventh comparator192 will also shut off theproportional solenoid114. The contact164cof thetwelfth relay164 will turn ON theproportional solenoid114 by delivering the ground to the normally closed contact112aof theseventh relay112, and the same way as described in with reference to a normal function.
• Theeleventh relay160 will open the contact so thepressure sensor74 is disconnected from the insufflator since it can not read the pressure when the smoke evacuator is activated. When an occlusion condition at the smoke evacuation is present, thevacuum sensor62 will send the signal at thefirst comparator64 and fromcomparator64, theoff time delay66 is activated which in turn will activate thethird relay42. The contact42awill open thereby stopping the smoke evacuator pump, and contact42bwill open thereby deactivating theproportional solenoid114 by removing the ground. At the same time, the occlusion visual andaudio alarm68 will turn on.
• While the invention has been particularly shown and described with reference to the preferred embodiments thereof, it will be understood by those skilled in the art that the foregoing and other changes in form and details may be made therein without departing from the spirit and scope of the invention.

Claims (12)

1. An automatic smoke evacuation and insufflation apparatus comprising:

a vacuum pump for removing at least one of a gas, smoke and debris from a surgical site; and

an insufflator for supplying a gas to a body cavity of a patient to maintain a desired pressure within the body cavity.

2. The apparatus ofclaim 1 further comprising at least one filter connected to the vacuum pump.

3. The apparatus ofclaim 1 further comprising at least one filter connected to the insufflator.

4. The apparatus ofclaim 1 further comprising at least one sensor for controlling the gas flow from the insufflator when the vacuum pump is turned on.

5. The apparatus ofclaim 1 further comprising a flow meter for measuring the flow of the gas from the insufflator.

6. The apparatus ofclaim 5 further comprising a gas warmer for warming the gas to a higher temperature when gas flow from the insufflator is high and warming the gas to a lower temperature when the gas flow from the insufflator is low.

7. The apparatus ofclaim 1 further comprising a vacuum sensor for sensing a vacuum level generated by the vacuum pump.

8. The apparatus ofclaim 7 wherein the vacuum sensor is capable of shutting off the vacuum pump when the vacuum level is lower than its set level.

9. The apparatus ofclaim 1 further comprising a pressure sensor for sensing an actual pressure within the body cavity.

10. The apparatus ofclaim 9 wherein the pressure sensor is capable of activating the vacuum pump if the actual pressure is too high so that gas is removed from the body cavity until the actual pressure returns to a normal level.

11. The apparatus ofclaim 9 further comprising at least one valve for shutting off the insufflator.

12. The apparatus ofclaim 1 further comprising at least one of an audio alarm and a visual alarm when a pressure within the body deviates from the desired pressure.

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